Surgical transversus abdominis plane block versus surgical rectus sheath block for postoperative pain control in morbid obese patients undergoing major gynaecological surgery: a prospective, randomized, blinded study

Abstract

Abstract Background Postoperative analgesia for major abdominal surgeries, especially with midline incisions, can be challenging particularly in morbid obese patients. This study aimed to compare surgical transversus abdominis plane (TAP) block and surgical rectus sheath (RS) block for postoperative analgesia in patients undergoing major gynaecological surgery regarding their efficacy and adverse effects. Sixty female patients aged 18–60 years were randomly allocated to two equal groups; (group TB, n = 30) patients received surgical TAP block, or (RB group, n = 30) patients received surgical RS block. Results Postoperative total morphine consumption was significantly higher among patients in the TB group than patients in the RB group (Mean ± SD; 18.2 ± 4.4 mg versus 14.3 ± 3.5 mg respectively, P value < 0.001). There was no significant difference between patients in either group regarding pain scores at rest and cough except at 6-h postoperatively when patients in the RB group experienced lower pain scores (P value < 0.001). The RB group showed better respiratory functions at the first hour, 6 h and 12 h postoperatively. There was no significant statistical difference between both groups regarding the incidence of postoperative complications. Conclusions Surgical RS block provided more favourable outcomes than surgical TAP block concerning postoperative analgesia in morbid obese patients with similar incidence of postoperative complications. Trial registration We carried out this trial at Ain-Shams University Hospitals, Cairo, Egypt, between October 2018 and January 2020. The study was approved by the Research Ethics Committee at the Faculty of Medicine, Ain Shams University (code number: FMASU R55/2018), and then registered in the ClinicalTrials.gov (registration no. NCT03732027) https://clinicaltrials.gov/ct2/show/NCT03732027 .

Keywords

• Postoperative
• Analgesia
• Obesity
• Gynaecology
• Pain
• Abdominal wall